Regional pain sufferers have less access to non-medication help for their condition – but in north-west Tasmania, pharmacists can help them access one option
In the wake of the codeine upschedule and what they describe as considerable catastrophic thinking about the issue among pain patients, a psychologist and physiologist are working together to offer free chronic pain programs.
Psychologist Bernadette Smith and exercise physiologist Simon West are encouraging pharmacists in the region to refer patients who they feel may be a good fit for the eight-week programs.
Two will be run in Burnie and two in Devonport this year. Ms Smith and Mr West have previously run them in the area, and have secured three years’ Commonwealth funding to continue, which they say is particularly important following the low-dose codeine upschedule.
The programs focus on a biopsychosocial model of care.
“In a regional area like this, we’re a bit reliant on our pharmacists,” Ms Smith told the AJP. “We encourage our patients to go back to the GP, but we also encourage them to have these conversations with their community pharmacist.
“They’re a bit of an underutilised resource in pain,” Ms Smith says. “That must be pretty frustrating for the pharmacists, because they’re dispensing a whole lot of stuff and they have more of an enduring relationship with these people.
“They often see a pattern emerging over time, and often have their hands tied. Pharmacists are often able to pick up those flags and those escalating prescribing histories or cocktails of medicine, and can point to the fact that some of these patients are in a bit of a downward spiral.
“Being able to pick up on those flags and make a referral would be absolutely perfect.”
Ms Smith says that psychosocial contributors to look out for include a history of post-traumatic stress, catastrophic thinking with regard to pain, depression and avoidant-type coping styles and strategies.
“Lack of social support, social isolation – and many of these people are on worker’s compensation as well,” she says. “In regional Tassie we have something like double the prescribing rate of opioids compared to mainland metropolitan areas.
“There’s less jobs, more poverty, a lower socioeconomic status, and less access to biopsychosocial models of care, hence more reliance on medication interventions. So pharmacists are in the perfect position of being able to help identify people.”
“We have to look at all aspects of pain – we can’t just look at one,” Mr West says. “Basically we look at a biopsychosocial approach, rather than just relying on one strategy, such as just medication or just surgery.
“We have to address other aspects contributing to the pain process. That’s not ignoring medication, but looking at other aspects from the pharmacist’s point of view.”
The program is based on education relating to the science of chronic pain and understanding the neuroplastic changes in the nervous system.
The focus is on improving function to bring about reduction in the pain experience as opposed to pain reduction before improving function.
Ms Smith says that following the rescheduling to Prescription Only of low-dose codeine, catastrophic thinking about how patients will manage their pain is circulating in the community.
“No doubt the poor pharmacists are copping the brunt of that, and copping the brunt of the push with health pathways around not prescribing opioids for chronic non-cancer pain,” she says.
Those engaged in a opioid reduction or cessation plan benefit from support explaining the merits and the implementation of the plan, they say.
Thus pharmacist understanding of the biopsychosocial model is essential in providing a consistent message to the patient that builds confidence in the process preventing patient confusion and minimising conflicting messages being received.
When pharmacists reinforce the same messages being given by GPs and providers like herself and Mr West, “that’s like gold,” Ms Smith says.
“When the pharmacist is saying the same thing as us, and it’s coming at them from different trusted sources, all of a sudden the patient is more likely to come on board, they see that the information is really congruent.”
Patients or pharmacists interested in the program can access it via www.psychologyplus.org.